The health care exchanges the GOP pretends not to like

The Affordable Care Act is a multi-faceted law, but one of the more important policy elements is the creation of “exchanges.” Republicans hate the idea – or at least, they pretend to – but now is probably a good time for them to get over it.

Exchanges, like the mandate, used to be a key GOP proposal. The word may seem wonky, but it’s a pretty simple idea: create a menu for consumers featuring coverage plans from private insurers. Americans can pick the plan that works best for them, and in order to participate, regulated insurers have to meet established standards. What’s more, under “Obamacare,” states set up their own exchanges, so it’s not some heavy-handed system imposed by Washington.

Sounds good, right? The public seems to think so – a recent national poll found 80% of Republicans approve of exchanges. But GOP voters and GOP officials aren’t on the same page, and many Republicans at the state level refuse to comply with the law.

Last week, former Senate Majority Leader Bill Frist (R-Tenn.) said his party is making a mistake, arguing there’s simply no reason for the GOP to fight against this worthwhile GOP idea. This Miami Herald report makes matters slightly worse for the right.

In the months before he became Florida House speaker, Marco Rubio crisscrossed the state searching for ways to make Florida better.

The best proposals, dealing with topics ranging from property taxes to education, became a book: 100 Innovative Ideas for Florida’s Future.

Chapter 8 is titled “Quality Healthcare at an Affordable Price,” and it includes Idea No. 87: “Florida should launch a marketplace of affordable health insurance.”

Yep, as recently as 2008, Marco Rubio, Mitt Romney, and many throughout the Republican Party thought exchanges made a lot of sense – they give consumers choices, they spur competition, they create a new private marketplace, etc.

But in 2012, the Republican plan from Rubio, Romney, and others is to destroy the exchanges before they’re created, guaranteeing fewer choices and less competition. (Rubio didn’t want to talk to the Herald about why he was for exchanges before he was against them.)

Incidentally, as we’ve talked about before, states that balk at creating exchanges invite the federal government to create, and possibly manage, exchanges for these states. The great irony of Republican intransigence at the state level is that they’re encouraging expanded federal control over health care in their states.

But for now, the Perrys, Scotts, Jindals, and Haleys of the GOP don’t care, and would rather have more federal control than comply with the ACA.